Małgorzata Milnerowicz, Jean-Philippe Desilles, Raoul Pop, Cyril Dargazanli, Julien Labreuche, Igor Sibon, Benjamin Gory, Sébastien Soize, Romain Bourcier, Mikael Mazighi, Christophe Cognard, Jildaz Caroff, Jean Christophe Gentric, Frédéric Clarençon, Sebastian Richter, Kevin Janot, Bertrand Lapergue, Gaultier Marnat
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引用次数: 0
Abstract
Background: Endovascular treatment (EVT) failures and early reocclusions in stroke often result from arterial wall disease, incomplete thrombus withdrawal, or acute endothelial injury. Intracranial and extracranial atherosclerosis, in particular, poses a risk of reocclusion, sometimes requiring tailored interventions (eg, angioplasty, stenting). While glycoprotein (GP) IIb/IIIa inhibitors have been widely studied in ischemic stroke, cangrelor remains less explored.
Objective: To evaluate the safety and efficacy of cangrelor compared with GPIIb/IIIa inhibitors in large vessel occlusion stroke (LVOS).
Methods: This retrospective analysis from the Endovascular Treatment in Ischemic Stroke Registry included patients from 34 French centers who received cangrelor or GPIIb/IIIa inhibitors during EVT between July 2018 and September 2023. Eligible cases had refractory occlusions or arterial disease at risk of reocclusion. The primary outcome was a 90-day favorable outcome. Secondary outcomes included excellent functional outcome, early neurological improvement, intracranial hemorrhage (ICH), procedural complications, and day 1 arterial patency. Propensity score overlap weighting was used for comparisons.
Results: Of 559 patients, 160 received GPIIb/IIIa inhibitors and 399 received cangrelor. Favorable outcomes were comparable (41.7% vs 43.7%; OR=1.1; 95% CI 0.61 to 1.93), as were rates of excellent functional outcome and early neurological improvement. Angiographic efficacy was similar, with modified Thrombolysis in Cerebral Infarction ≥2b rates of 89.5% for GPIIb/IIIa and 90.1% for cangrelor. No significant differences were observed in day 1 patency, 90-day mortality, or symptomatic ICH.
Conclusions: Cangrelor showed comparable safety and efficacy to GPIIb/IIIa inhibitors. These results, along with the specific pharmacodynamics, make this drug a promising agent in the acute management of complex intracranial and extracranial LVOS.
背景：脑卒中的血管内治疗（EVT）失败和早期再闭塞通常是由动脉壁疾病、血栓不完全清除或急性内皮损伤引起的。尤其是颅内和颅外动脉粥样硬化，会造成再闭塞的风险，有时需要量身定制的干预措施（如血管成形术、支架植入）。虽然糖蛋白（GP） IIb/IIIa抑制剂在缺血性卒中中的应用已被广泛研究，但对康格瑞洛的研究仍较少。目的：比较康格瑞洛与GPIIb/IIIa抑制剂治疗大血管闭塞性卒中（LVOS）的安全性和有效性。方法：回顾性分析来自缺血性卒中血管内治疗登记的34个法国中心的患者，这些患者在2018年7月至2023年9月期间接受了cangrelor或GPIIb/IIIa抑制剂的EVT。符合条件的病例有难治性闭塞或有再闭塞危险的动脉疾病。主要结果是90天的有利结果。次要结局包括良好的功能结局、早期神经系统改善、颅内出血（ICH）、手术并发症和第1天动脉通畅。倾向得分重叠加权用于比较。结果：在559例患者中，160例患者接受GPIIb/IIIa抑制剂治疗，399例患者接受canrelor治疗。两组的良好结局相当(41.7% vs 43.7%；或= 1.1;95% CI 0.61 ~ 1.93)，良好的功能结局和早期神经系统改善的比率也是如此。血管造影疗效相似，改良后的脑梗死≥2b溶栓率GPIIb/IIIa为89.5%，canrelor为90.1%。在第1天通畅、90天死亡率或症状性脑出血方面没有观察到显著差异。结论：Cangrelor的安全性和有效性与GPIIb/IIIa抑制剂相当。这些结果，以及特定的药效学，使该药在复杂的颅内和颅外LVOS的急性治疗中有前景。试验注册号：NCT03776877。
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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